- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,481.54
| Facility | | $1,862.09 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $6,456.54
| Professional | | $2,344.23 | $2,754.23 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $28,183.83
| Facility | | $4,677.35 | $13,803.84 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,388.44 / $6,606.93
| Professional | | $2,137.96 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,623.41 / $17,378.01
| Facility | | $398.11 | $5,623.41 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,073.80 / $8,709.64
| Professional | | $2,344.23 | $4,073.80 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,311.31 / $6,309.57
| Professional | | $2,238.72 | $3,311.31 | $6,309.57 |